Suicide Crisis Syndrome: Examining Supporting Evidence and Barriers to Diagnostic Validity

Igor Galynker¹Lisa Cohen^2*Anna Stefania Prekas¹Mary King¹Yael Apter Levy¹

• ¹Icahn School of Medicine at Mount Sinai, New York, United States
• ²Carl Icahn School of Medicine at Mount Sinai/Mount Sinai Behavioral Health Center, New York, United States

Despite decades of research, our understanding of the suicidal mind in the short term remains limited, contributing to over 700,000 deaths annually worldwide (World Health Organization [WHO], 2024). We must, therefore, critically evaluate our paradigms, which currently rely on self-reported suicidal ideation and the broader construct of suicide risk, and we must develop new prevention frameworks to facilitate meaningful change. We propose that the Suicide Crisis Syndrome (SCS), a novel suicidal state currently under review for inclusion in future editions of the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition, Text Revision (DSM-5-TR), offers such a framework. SCS addresses a key gap in psychiatric nosology by systematically identifying individuals at imminent risk (Barzilay et al., 2020; Bloch-Elkouby, Gorman, Lloveras, et al., 2020b). As the final, acute stage of the Narrative Crisis Model (NCM), SCS traces suicidal progression from chronic risk to imminent crisis without relying on self-reported intent (Galynker, 2017; Bloch-Elkouby et al., 2021; Bloch-Elkouby et al., 2020b; Cohen et al., 2022; Galynker et al., 2024). This model provides a basis for treatments targeting each stage of suicidality (Galynker et al., 2024). Establishing SCS as a suicide-specific diagnosis could shift prevention efforts and reduce rising suicide rates. The purpose of this review is to evaluate the experimental evidence supporting the classification of Suicidal Crisis Syndrome (SCS) as a distinct clinical entity. Our approach builds on a previously published review in Frontiers that examined the proposed inclusion of Suicidal Behavior Disorder in the DSM (Fehling & Selby, 2021). Specifically, we assess the extent to which the proposed diagnosis of SCS satisfies—or fails to satisfy—the Feighner criteria (Feighner et al., 1972) and Kendler's (2009) guidelines for the inclusion of new diagnoses in the DSM. Accordingly, this paper does not address broader arguments for or against the formal inclusion of a suicide-specific diagnosis in the DSM that fall outside the domain of empirical research.